SURVIVAL STRATEGIES FOR SAFETY NET DENTAL CLINICSTHURSDAY OCTOBER 20, 2011

M. Frank Beck, DDS, FAAHD, MAGD, FICOI, DSCDADental Program Director

                                                                                                  

                                                                                                             

                     

Catholic Healthcare Partners CHP

Description:• Internal Medicine Clinics• Pediatric Clinic• Women’s Health Center

• Pre-Natal Clinic• Gynecological Clinic

• Surgical/Trauma Clinic• Ambulatory Care Pharmacy• WIC Program• Prescription Assistance

Program• Specialty Clinics

St. Elizabeth Health CenterAmbulatory Care Center

1. Provide health services to the ambulant patient of low income, no insurance and under insured referrals from other physicians, surgeons, Family Health Center (but not limited to this group).

2. Provide for diagnosis and treatment of disease entities.

3. Provide preventive health education and promote wellness on patient and family basis.

4. Provide education and training opportunities for Ambulatory Care medical residents and medical/nursing students and related health professions.

Ambulatory Care CenterPurpose of Service

Mission Statement

The mission of the Ambulatory Care Center is to provide individuals with health care, which includes prevention, diagnosis, treatment, and education regardless of their economic status. We are committed to delivering high quality medical care to everyone in need, with an emphasis on the poor and underserved residents within the community.

As a teaching facility for the residency programs, the Ambulatory Care Center is also devoted to providing residents and students an education that emphasizes proper medical treatment as well as concern and respect for our patients and community.

The Ambulatory Care Center is part of the Humility of Mary Health Partners, which continues the healing ministry of the Sisters of Humility of Mary.

QUALITY

Adj : Grades of excellence

Hospital-Based Safety Net Dental Clinic

General Practice Dental Residency Program

Dental Clinic

SCOPE OF SERVICES PROVIDED

Mobile Dental Vans

Inpatient Floor

Consults

Emergency

Department

Consults

Operating

Room

Community

Education

Floor Follow-

ups

Emergency Follow-

ups

SCOPE of SERVICES PROVIDED

DENTAL CLINIC

MOBILE DENTAL VANS

INPATIENT FLOOR CONSULTSFOLLOWUP TREATMENT

EMERGENCY ROOM CONSULTS FOLLOWUP TREATMENT

The dental residents/ faculty provide coverage for 24 hour emergent care.

This enables dental pathology to be intercepted and treated at an earlier stage of progression.

Early interception of dental pathology prevents fulminant progression and extension to involve and exacerbate existing systemic co-morbidities.

Not only does this reduce risk for the patient, but also significantly reduces cost to the hospital facility by preventing multi-organ system involvements.

LEVEL ONE TRAUMA CENTER

OUTPATIENT ORAL SURGICAL/GENERAL DENTAL PROCEDURES IN THE MAIN OPERATING ROOM One of only three sites in the tri-county area to provide

for comprehensive dental needs for the mentally-challenged, developmentally disabled, pediatric and frail/elderly.

CDC data clearly demonstrates that people with disabilities and complex health conditions are at greater risk for oral disease.

Early access to dental care will obviously prevent the progression of dental disease to a more fulminant pathology.

However, less obvious is the fact that early access to dental care will also prevent the fulmination of coexisting systemic disease such as, CV, DM, HBP.

COMMUNITY EDUCATION

The faculty, residents and staff educate the community regarding oral health and provide direction so members of the community may access the dental services they need.

If You don’t know where your going ….

Any road will get you there!

SYSTEMS OF MANAGEMENT

Ensure Consistent Delivery of Care

Ensure Continuity of care

DEVELOP AND IMPLEMENT POLICIES AND PROCEDURES

DEVELOP/IMPLEMENT INSTRUMENTS TO MEASURE & EVALUATE PERFOMANCE

PERFORMANCE PARAMETERS

SAFETY NET DENTAL CLINIC

PATIENT CARERESIDENT

EDUCATION

Individually

Collectively

Faculty Residents

DENTAL CLINIC PERFORMANCE MEASURES

BaselineGross Charges Expenses # of Visits Rev per

visitCost per visit # of Unduplicated

PtsNew pts

# of Transactions/visit

No-Show Rate Emerg Rate

# Children receiving sealants <21

TOTAL # sealants applied

3 mo

6 mo

9 mo

12 mo

15 mo

18 mo

21 mo

24 mo

DDS RDH CDA**

# of completed treatments TPC’s

1-30 31-60 61-90 91+ Medicaid Sliding Fee 0 paySliding Fee 20% or more

Sliding Fee Scale

Commercial Ins

Other

3 mo

6 mo

9 mo

12 mo

15 mo

18 mo

21 mo

24 mo

DENTAL CLINIC PERFORMANCE MEASURES

BaselineGross Charges

Expenses

# of Visits

Rev per visit

Cost per visit

# of Unduplicated Pts

New pts

# of Transactions/visit

No-Show Rate Emerg Rate

# Children receiving sealants <21

TOTAL # sealants applied

3 mo 2.64

6 mo 2.68

9 mo 2.50

12 mo 3.42

15 mo 3.27

18 mo 3.42

21 mo 3.7

24 mo

# OF TRANSACTIONS/VISIT

2.64 3.7 40% increase!

AVG # PROCEDURES/ENCOUNTER

Ohio Safety Nets 2.4

RELATIVE ANNUALIZED # PT VISITS

3665 Pt Visits / 6months (3.7 vs. 2.4)

Effectively Translates 5650 Pt Visits

NET RESULT OF INCREASE #CPT/VISIT

Increase Revenue/Visit Decrease Cost/Visit Increase Sustainability

OPERATORY TURNAROUND

Disinfect/Set-up Operatory

Meet/Greet/Seat Patient Procedure (procedures)** Operatory Breakdown Dismiss patient Documentation

Economy of Time Economy of Materials Favorable Ergonomics - by

minimizing repetitive tasking

Additional Considerations

HOW do we accomplish this?

Conversion of OBSTACLES into OPPORTUNITIES

• No Show Rate

• Transportation Barriers

• Re-Appointment

Intervals

• Follow-Up Compliance

OBSTACLES

INCORPORATION OF OPEN/CLOSED DENTAL APPT CONCEPTS

Quadrant dentistry for those sitting in chair when next patient no shows.

Continuation of serial appointments Conversion of emergency

appointments to definitive care.

DENTAL CLINIC REVENUE SOURCESBaseline

EAGLESOFT Med Cross Codin

g

ER

FloorConsults

IME/DME$564,000

Medicaid DME

DSHAnthem100,000

ODH65,000

CHP25,000

HMHP112,000

1000 ACC/RF1500

HRSA Equip

HRSA Curr

In Kind Grant Support HMHP Totals

Grant TotalsIn Kind Support HMHP

3 mo 76,125

6 mo 76,125 ***

9 mo 1st 76,125 ***

12 mo 2nd

15 mo 3rd

18 mo 4th

21 mo

24 mo

Facility Fees Professional Fees

GRANTS

Med Cross Coding

DEFINITIVE CARE DENTISTRY

Only a dentist is trained and licensed to provide the DEFINITIVE CARE that the oral health needs of Ohioans require

Without access to the definitive care provided by the dentist, many patients have sought care in a more costly setting such as a hospital emergency room.

DEFINITIVE DENTAL CARE CONT’D

Treatment of patients requiring dental care in a hospital emergency room generally consists of little more than two prescriptions: An antibiotic for infection An analgesic for pain

Thus, the patient receives only symptomatic relief and re-enters the system in the future presenting more fulminant pathology, requiring the utilization of even more resources

DEFINITIVE DENTAL CARE CONT’D

In some cases the results of poor dental care have been deadly. A child in Mississippi and another in Maryland died in 2008, as a result of infections caused by decayed teeth.

A similar life-threatening situation presented to SEHC Dental Clinic late in 2008 when a high risk 3rd trimester female presented to the dental clinic with multiple decayed and abscessed teeth. OB/GYN consultation was obtained, appropriate

medications prescribed and surgery scheduled The patient did not show for surgery Next presentation to EOR via ambulance in coma

UNNECESSARY VISITS IN THE EMERGENCY ROOM

METHODS

Level I and II visits at SEHC Main ED from 10/07 thru 08/08 were analyzed (n = 3,088). Data provided by S. Rivello.

Each encounter ICD9 diagnosis was reviewed to ascertain its necessity as a ED visit (by DG). Any encounter with associated procedures was considered necessary.

Variables analyzed included self pay status, demographics, charges, and temporal variability.

391

180154

92

8560

40

4035

33

3131

30

2727

26

2422

22

2019

18

1816

16

1312

10

106

Dental

Dermatitis

Otitis media

Back sprain

Conjunctivitis/blepharitis/chalazion

Backache/ lumbago/ disc

URI/ cough

STD/ VD/ HIV testing

Allergy

Hives

Limb cramp/ myalgia

Scabies

Repeat prescription

Bronchitis/ asthma

Pharyngitis/ Nasopharyngitis/strep

Hypertension

J oint pain/ osteoarthritis

Sinusitis/ rhinitus

Earwax

Dressing change/ sutures

Chronic pain

Anxiety

Other

Bipolar/ depression/mental health

Viral/ varicella

Cervicalgia

Other sprain

Gout

UTI

Vaginitis

UNNECESSARY ED VISIT BY TOP 30 DIAGNOSIS ICD9

DEVELOPMENT AND IMPLEMENTATION OF DEFINITIVE CARE CLINIC

Our experiences in providing access to oral health care has clearly demonstrated that the PRIMARY motivating factor responsible for our patient population seeking care is PAIN not PREVENTION

ER CONSULT BY DENTAL RESIDENT

Rx Antibiotic Rx 1-2 Analgesics LA Injection Appt 700am following day

INSTITUTIONAL QUALITY OF CARE

Render definitive care Most appropriate venue Most cost effective manner

PERFORMANCE PARAMETERS

SAFETY NET DENTAL CLINIC

PATIENT CARERESIDENT

EDUCATION

Individually

Collectively

Faculty Residents

PATIENT CARE QUALITY ASSESSMENT

Collectively

Individually

COLLECTIVELY

Community Impact Performance measures

DENTAL CLINIC PERFORMANCE MEASURES

BaselineGross Charges Expenses # of Visits Rev per

visitCost per visit # of Unduplicated

PtsNew pts

# of Transactions/visit

No-Show Rate Emerg Rate

# Children receiving sealants <21

TOTAL # sealants applied

3 mo

6 mo

9 mo

12 mo

15 mo

18 mo

21 mo

24 mo

DDS RDH CDA**

# of completed treatments TPC’s

1-30 31-60 61-90 91+ Medicaid Sliding Fee 0 paySliding Fee 20% or more

Sliding Fee Scale

Commercial Ins

Other

3 mo

6 mo

9 mo

12 mo

15 mo

18 mo

21 mo

24 mo

INDIVIDUALLY

HMHP Physician Practice Satisfaction Surveys

Quarterly

PERFORMANCE PARAMETERS

SAFETY NET DENTAL CLINIC

PATIENT CARERESIDENT

EDUCATION

Individually

Collectively

Faculty Residents

RESIDENT EDUCATION QUALITY ASSESSMENT

CODA Standards

Resident Continuous QA/QI

Resident Repetition Sign off Sheets

QT Eval of Residents by Faculty

QT Faculty Evals

Residents

DME

CODA STANDARDS

CODA STANDARDS Table of Contents PAGE

Mission Statement of the Commission on Dental Accreditation .............................................. 2 Accreditation Status Definitions .................................................................................................. 3 Introduction ................................................................................................................................. 4 Goals ............................................................................................................................................. 6 Educational Environment ............................................................................................................ 9 Definition of Terms Used in Accreditation Standards ............................................................ 14 Accreditation Standards for Dental Education Programs ...................................................... 17 1- Institutional Effectiveness ............................................................................................ 17 2- Educational Program.................................................................................................... 20 2-1 Instruction ............................................................................................................. 20 2-3 Curriculum Management ...................................................................................... 20 2-9 Critical Thinking ................................................................................................... 22 2-10 Self-Assessment .................................................................................................... 23 2-11 Biomedical Sciences ............................................................................................. 23 2-15 Behavioral Sciences .............................................................................................. 24 2-17 Practice Management and Health Care Systems .................................................. 25 2-20 Ethics and Professionalism ................................................................................... 25 2-21 Clinical Sciences ................................................................................................... 26 3- Faculty and Staff ........................................................................................................... 29 4- Educational Support Services ...................................................................................... 30 4-1 Admissions ............................................................................................................ 30 4-5 Facilities and Resources ........................................................................................ 30 4-6 Student Services .................................................................................................... 31 4-7 Student Financial Aid ........................................................................................... 31 4-9 Health Services ..................................................................................................... 31 5- Patient Care Services .................................................................................................... 33 6- Research Program ........................................................................................................ 35

CODA STANDARDS

Mission Statement of the Commission on Dental Accreditation

The Commission on Dental Accreditation serves the public by establishing, maintaining and applying standards that ensure the quality and continuous improvement of dental and dental-related education and reflect the evolving practice of dentistry. The scope of the Commission on Dental Accreditation encompasses dental, advanced dental and allied dental education programs.

Commission on Dental Accreditation Revised: January 30, 2001

RESIDENT CONTINUOUS QA/QI PARTICIPATION

RESIDENT STEP REPETITION SIGN OFF SHEETS

QT EVAL OF RESIDENTS BY FACULTYST. ELIZABETH HEALTH CENTER

EVALUATION OF COMPETENCIES GENERAL PRACTICE DENTAL RESIDENCY PROGRAM

Resident: ___________________ Evaluation Period: _________________ Faculty: ______________________________________________ Date:_________________________ Faculty Signature:_______________________________________ Please circle the number corresponding to the resident’s performance in each area. Unsatisfactory= Several behaviors performed poorly or missed (rating 1, 2 or 3) Satisfactory= Most behaviors performed acceptably (ratings 4, 5,or 6); satisfactory performance is described below) Superior= All behaviors performed very well (ratings 7,8, or 9)

Unsatisfactory Satisfactory Superior Professionalism 1. Demonstrates integrity and 1 2 3 4 5 6 7 8 9

ethical behavior; Accepts Takes responsibility for actions willingly; admits mistakes; puts patient responsibility and follows needs above own interests; recognizes & addresses ethical dilemmas & through on tasks conflicts of interest; maintains patient confidentiality; is industrious & dependable; completes tasks carefully & thoroughly; responds to requests in a helpful & prompt manner.

2. Practices within the scope 1 2 3 4 5 6 7 8 9

of his/her abilities Recognizes limits of his/her abilities; asks for help when needed; refers patients when appropriate; exercises authority accorded by position and/or experiences.

3. Demonstrates care and 1 2 3 4 5 6 7 8 9

concern for patients and Responds appropriately to patient & family emotions; establishes rapport; their families regardless of provides reassurance; is respectful & considerate; does not rush; is sensitive age, gender, ethnicity or to issues related to each patient’s culture, age, gender & disabilities; provides sexual orientation; Responds equitable care regardless of patient culture or socioeconomic status. to each patient’s unique characteristics and needs

Interpersonal & Communication Skills 4. Always demonstrates integrity, respect 1 2 3 4 5 6 7 8 9

compassion, and empathy for patient. Establishes trust. Primary concern is for the patient’s welfare. Maintains credibility, excellent rapport with patients and families.

5. Communicates effectively 1 2 3 4 5 6 7 8 9 with other healthcare Maintains complete & legible medical records; writes clear & concise

professionals consultation reports & referral letters; makes organized & concise presentations of patient information; gives clear & well-prepared presentations. 6. Works effectively with 1 2 3 4 5 6 7 8 9

other members of the Demonstrates courtesy to and consideration of consultants, therapists, healthcare team & other team members; invites others to share their knowledge & opinions; makes requests not demands; negotiates & compromises when disagreements

occur; handles conflict constructively.

Dental Knowledge 7. Extensive and well applied. Knowledge 1 2 3 4 5 6 7 8 9

Of disease, pathophysiology, diagnosis and Therapy. Consistently up-to-date. Self- Motivated to acquire knowledge. 8. Identifies all the patient’s problems. 1 2 3 4 5 6 7 8 9

Interrelates abnormal findings with altered dental pathology. Establishes sensible differential diagnoses. Provides orderly succession of testing, therapeutic recommendations and treatments. Educates patients and families. Provides high quality, appropriate, cost effective and comprehensive care.

QT EVAL OF FACULTY BY RESIDENTS

St. Elizabeth Health Center Department Of Dental Education

EVALUATION of CORE FACULTY by RESIDENTS

Academic Year: 2011-2012 Dates:_ J uly – October 2011______

Please evaluate the faculty listed below, rating in all of the categories or indicating N/A. Faculty Name _________________ TEACHING CATEGORIES Excellent Good Fair Poor N/A 1. Teaching Enthusiasm 2. Overall Teaching Ability a. Basic Science b. Clinical Science c. Lecture Content d. Operating Room e. Conference Attendance f. Conference Participation 3. Were there personality conflicts? Yes No I f yes, please explain: 4. Recommendations/comments: RESIDENT _____________________SIGNATURE_________________________________

Please return to Larissa McElrath, Dental Education ASAP Eval. by Res.-of Core Faculty (qt.

DIRECTOR OF MEDICAL EDUCATION

• Completes Statistical Analysis and Evaluation

• Faculty/Resident Retention, Advancement or Termination